Can a disability insurance company rely upon a nurse to review my disability claim?

Hartford and many other disability insurance companies employ nurses to do preliminary reviews of medical records. The cost of a nurse on staff versus a physician is much less for a disability insurance company. Also, the claim rep assigned to your disability insurance claim is not a medical profession and they have no idea how to interpret your medical records.

It is OK for an insurance company to use a nurse, but if the nurse makes a determination that differs from your orthopedic, then it is a big problem for the insurance company.

Unfortunately, these nurses think they know more than some doctors and we have seen Hartford Disability Claims denied based upon only a nurse review.

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There are 3 comments

  • Vickie,

    Review your applicable policies. Most will have worker’s compensation as an “Other Income Benefit” subject to offset. If your policies indicates same then the entity that issued disability benefits (be it employer or the insurance company) would have right to collect repayment of an overpayment.

    Stephen JessupSep 10, 2013  #3

  • FYI: Sedgwick CMS and Hartford merged a few years ago. My employer is self insured the employer accepted my injury but sent me over to their STD instead of paying WC no TD or PD was paid. The employer is now attempting to recover STD through subrogation. However the STD was not paid by the TPA it was paid by the employer. If the employer recoups STD from any WC settlement wouldn’t that constitute me paying for my own WC since the employer is self insured and paid out the STD payments.

    Vickie WilliamsSep 9, 2013  #2

  • Yes, this is what I am going through. My STD case was closed even though I continue sending doctor forms saying I had acute illness; still for two more months now they say nurse is reviewing my case. They’re now saying the doctor took me off for one more month and did not have a good explanation saying due to surgery recovery was not good enough words. I was still having severe pains and between the surgeon, my primary physician, and a gasterologist I was taking antibiotics and pain medicine which kept me drowsy, dizzy and stressed out. No one could really know the pain I was feeling. How can a nurse ever question a surgeon taking a patient off work, I don’t understand! I only received one or two week paycheque from Cigna short term disability and was off work a total of 11 weeks. Now I have been back to work and still can’t get paid.

    ConfusedSep 4, 2013  #1